[PP.03.29] LIPID PROFILE AND INCIDENCE OF CARDIOVASCULAR DISEASE IN A MEDITERRANEAN HIGH-RISK POPULATION: THE ESCARVAL-RISK STUDY

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Abstract

Objective:

The aim of the study was to assess the association of different components of the standard lipid profile with the total mortality and the incidence of cardiovascular events in a Mediterranean high cardiovascular risk population.

Design and method:

Prospective cohort ESCARVAL study, including patients without previous cardiovascular disease, older than 30 years. Patients were selected in primary care, consecutively, among individuals with a diagnosis of hypertension (HT), dyslipidemia (DL) or diabetes mellitus (DM) in the absence of CV events. The follow-up period was 3.2 years (2008–2012). The following lipid biomarkers were compared: Total cholesterol (TC), HDL-cholesterol (HDLc), Non-HDL-cholesterol (NHDLc), LDL-cholesterol (LDLc), Non-HDL minus LDL-cholesterol (NHDL-LDLc); Triglycerides (TG), ratio Total/HDL-cholesterol (TC/HDLc), ratio Triglycerides/HDL-cholesterol (TG/HDLc). The endpoints were: mortality for all causes, coronary heart disease or stroke in-hospital admission. Adjusted rate ratios (ARR), annual attributable risk and Population attributable risk (PAR) associated to altered lipid levels were calculated.

Results:

51,462 patients aged 62.6 (average) years old (52.4% women), were included. During a follow-up time of 3.2 years, 919 deaths, 1666 hospitalizations for coronary heart disease (CHD) and 1510 hospitalizations for stroke were recorded. The lipid biomarkers that showed higher ARR for total mortality and CHD and Stroke hospitalization by altered lipid levels were respectively: HDLc < 40 mg/dL in men or < 50 mg/dL in women 1.25 (1.09, 1.43), 1.29 (1.16, 1.42), 1.23 (1.1, 1.37); TC/HDLc > 5 in men and > 4.4 in women 1.22 (1.04, 1.43), 1.38 (1.23, 1.54), 1.25 (1.11, 1.4) and TG/HDLc > 3.5 in men and > 2.5 in women 1.21 (1.06, 1.38), 1.3 (1.18, 1.43), 1.09 (0.98, 1.21). The lipid biomarkers that showed higher PAR (%) were respectively: low HDL: 7.70 (3.56, 11.81), 11.42 (8.06, 14.77), 8.40 (4.99, 11.86), high TC/HDLc: 6.55 (3.16, 9.94), 12.47 (9.69, 15.26), 8.73 (5.87, 11.59) and high TG/HDLc: 8.94 (4.58, 13.24), 15.09 (11.42, 18.79), 6.92 (3.12, 10.69).

Conclusions:

HDLc, and the ratios total cholesterol/HDL-cholesterol and triglycerides /HDL-cholesterol seem to be better markers of the risk of vascular disease compared to other biomarkers commonly used in clinical practice.

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